• Brian A Williams, Michael L Kentor, James J Irrgang, Matthew T Bottegal, and John P Williams.
• Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
• Reg Anesth Pain Med. 2007 May 1; 32 (3): 193-202.

Background And ObjectivesWe analyzed discharge outcome data after anterior cruciate ligament reconstruction (ACLR) under spinal anesthesia including a perineural femoral catheter and multimodal analgesia/antiemesis. The outcomes specifically addressed in this report are nausea, vomiting, and retching (NVR) and quality of sleep/difficulty falling asleep/daytime restfulness.MethodsACLR patients were randomized to saline or 0.25% levobupivacaine as a bolus and/or 50-hour infusion. Patients completed the Quality of Recovery 40-item (QoR-40) survey on postoperative days 1 to 4. We analyzed predictors of perfect responses (i.e., no NVR and perfect sleep-restfulness) by pooling these specific QoR-40 items. Prospectively collected QoR-40 data were analyzed retrospectively.ResultsData from 233 participants were analyzed. The addition of the femoral nerve block or perineural catheter did not predict associated improvements in NVR or sleep-restfulness. Previous days' NVR was the most consistent predictor of subsequent NVR, whereas gender and opioid consumption were less consistent predictors. Smoking status was not predictive of NVR. Previous days' sleep-restfulness was a consistent predictor of subsequent sleep-restfulness, whereas the presence of any moderate pain was a less consistent predictor of sleep-restfulness.ConclusionsNVR and quality of sleep-restfulness after the described regional anesthetic with multimodal analgesia and antiemesis is reported. Smoking status was not a predictor of NVR, and gender and opioid consumption were not consistently predictive of NVR. The addition of a femoral nerve block to the described multimodal technique was not associated with NVR or quality of sleep-restfulness.

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